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RespiratoryNov 22, 2022

Respiratory physios' 'key role' in specialised weaning units highlighted in consultation document

Physiotherapy is an ‘integral part’ of multidisciplinary teams that ‘wean’ patients who have been receiving complex ventilation, according to a draft consultation document developed by the British Thoracic Society (BTS) and the Intensive Care Society.

The Model of care document for specialised weaning units (SWUs) has been publicly available on the BTS’s website since 27 October, and interested parties have until 1 December to log their responses.

A section in the document devoted to physiotherapy is unequivocal about the need for the profession’s involvement in SWUs, stating: ‘An experienced respiratory physiotherapist with highly specialist knowledge should be appointed and work with the lead medical consultant and lead nurse.’

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The deadline to respond to the draft consultation document is 1 December 2022


Physiotherapist co-author Ema Swingwood

A total of 29 authors drew up the document, among them Ema Swingwood, former chair of the Association for Chartered Physiotherapists in Respiratory Care. Ms Swingwood received an OBE in 2021 in acknowledgment of her ‘services to physiotherapy’, when she was respiratory pathway lead at University Hospitals Bristol and Western NHS Trust. Her Twitter account describes her as an NIHR Clinical Doctoral Research Fellow.

Many SWU patients ‘have multifaceted needs around rehabilitation’ and need highly skilled treatment’, the document notes. ‘Interventions delivered by respiratory physiotherapists include secretion management, cough augmentation, advanced ventilation strategies, mobilisation, and rehabilitation.’ Such tasks do not constitute an exhaustive list and could be expanded, dependent on the services required and clinician’s skills, with arterial and capillary blood gases being one example.

‘Together with therapy support workers and the wider team, physiotherapists have a key role in early mobilisation and weaning initiation to mitigate the risks of prolonged mechanical ventilation, including improving functional independence, minimising inpatient length of stay and facilitation of a timely and effective discharge from the SWU.’

Patients on SWUs would benefit from being part of planning their own care, the document suggests.

Physiotherapists have a key role in early mobilisation and weaning initiation to mitigate the risks of prolonged mechanical ventilation ... improving functional independence, minimising inpatient length of stay and facilitation of a timely and effective discharge 

What are the attributes of ‘experienced respiratory physiotherapists’?

They would have advanced clinical knowledge and experience in managing patients with complex ventilation and weaning needs, rehabilitation, leadership and management.

They would share responsibility for training and development of the SWU team. A job plan for such a post would include all key areas of advanced practice and offer dedicated time for clinical work alongside leadership, research and service/quality improvement.

Good skill mix 'vital'

Maintaining a good skill mix is ‘vital’ and would include support from senior permanent and rotational physiotherapists, the document notes. Indeed, larger units might develop the role of a consultant physiotherapist.  

‘Each patient’s acuity and rehabilitation needs should be considered and is dependent on their clinical complexity.’ This would require working in conjunction with the wider allied health professional team and may require protected time and access to a suitable rehabilitation facility to provide rehabilitation.  

On-call physiotherapists with adequate training to ensure they can manage complex ventilation patients should be available ‘24/7’. At least 0.25 whole time equivalent physiotherapist for each weaning bed is recommended, in addition to the physiotherapy complement in the complex long term ventilation team, the document adds.

What are SWUs?

SWUs are designed to enable an effective step down from critical care for patients who continue to require invasive mechanical ventilation, following prolonged admission. Their purpose is to achieve weaning to the least invasive method of respiratory support.  

To see the document in full, visit: https://www.brit-thoracic.org.uk/delivery-of-care/models-of-care/specialised-weaning-units/

Comments on the draft document should be returned by 1 December 2022. Email: miguel.souto@brit-thoracic.org.uk


Author: Ian A McMillan
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